Towards Better Reproductive Health in Eastern Europe. Concern, Commitment and Change by G. s> Lindmark M. Horga A. Campana , J. Kasonde (review)

Abstract

386 SEER, 79, 2, 200I This is definitelynot a book to be recommended to mainstreameconomists, and not even to 'transitologists'keen on economic developmentsonly. This is a book to take on an air flight or better a railway trip and to enjoy withoutprejudice. ISMEA(Institute ofApplied Mathematics andEconomics) M. LAVIGNE Paris Lindmark,G.; Horga, M.; Campana, A. and Kasonde,J. (eds). Towards Better Reproductive HealthinEastern Europe. Concern, Commitment andChange. WHO Scientific Working Group on Reproductive Health Research. Central European University Press, Budapest, and WHO, Geneva, I999. xiv + 150 pp. Tables. Figures.Bibliographies.?9.99 (paperback). THE identificationof a significantgap in healthstatusand healthcare between the post-Communist countries and those of advanced Western economies predatedthefallof Communism,but the shocksand dislocationsof 'transition' saw the gap widening. Graveconcernshave been expressedfor manyyearsat the numerous examples of deteriorating indices of health, including basic indicators such as life expectancy and infant mortality. Premature male mortalityattractedparticularattention.Onlyveryrecentlydidtheseindicators improve in certaincountriesof CentralEurope;but furtherdeteriorationwas evident throughoutmost of the formerSoviet Union. A study of reproductive health ought therefore to be very welcome, not least because the health gap is paralleledby a researchgap in this area. Even the thoughtful,wide-rangingrecent studyby William Cockerham(Healthand SocialChange inRussiaandEastern Europe, London, i999) largelyignoreswomen in generaland reproductivehealthin particular.Unfortunately,thiscollection of chaptersby the WHO ScientificWorkingGroup on Reproductive Health Research is tedious and repetitive. Its data are drawn mainly from the first half of the I99os, so that it does not even have the merit of providing an upto -date overview. Some of the data do not appear consonant with those available elsewhere, such as the surprising figures for life expectancy in Turkmenistan of 62 years for women and 69 for men (Honjanen and Benagiano, p. 2). It is not that the materialsprovided offeran erroneouspicture. Indeed, the problems identified will be all too familiar to the 'policymakers and programmemanagers'who are the targetaudience. These includehigh levels of maternal and infant mortality, low use of contraception, high abortion rates,yet risingteenage pregnancies, and an epidemic of sexuallytransmitted disease,probablylinkedto infertility.The reasonsadduced for suchproblems are also familiar ones. Some are a result of health care organization and medical practice. They include the lack of emphasis on primaryprevention, poor standardsof medical training (forobstetricsand gynaecology, if not for dermatology and venerealogy), authoritarianattitudes to and little involvement of patients with their care, the persistence of traditionalpractices and obsolete treatmentregimens.Othersarea resultoflackof resources,especially with regardto familyplanning servicesand contraception,with abortion still REVIEWS 387 the main means of fertilitycontrol. This is particularlyimportant given the strong association between lack of contraception and maternal, infant and perinatalmortality(Kovacs, p. 9 I). Moreover there is an absence of integration of health and education, in particularsex education, and a similarlackof coordinationprevailswith regardto linksbetween health care and police and social services. These points, and general considerations of economic dislocation , are not part of a sustainedanalysisor a unified theme developed in particularchapters. Despite the recognition of variation between and within countries,and numerouschartsand tablesto illustratethe former,there is no sustained comparative analysis of the reasons for such differences. The political, social and economic context of post-Communist transformation appearsonly at the margins.The particularissuessurroundingredefinitionof gender roles and the specific impact of this profound change on women are addressednot at all. Moreover, the solutions offeredare either obvious or wildly unrealistic.In the first category are pleas for the establishment of efficient and sensitive family planning services and free contraception. The second includes recommendationsfor a qualityassuranceprocess,includingsetting'standards for quality of care in structure, process, and outcomes' (Lindmark,p. 30). Scholarsand otherinterestedpersonswillfindlittleto stimulatetheirinterest. Department ofGovernment FRANCESMILLARD University ofEssex Lavenex, Sandra. SafeThirdCountries. Extending theEU Asylum andImmigration Policiesto Central andEastern Europe. Central European University Press, Budapestand New York,i999. xii + I89 pp. Notes. Bibliography.Index. ? 13.95 (paperback). THE aim of this book is to demonstrate that the European Union's (EU's) currentasylumregimewhich isgearedtowardscombatingillegalimmigration, weakensthe principles,normsand rulesof internationalrefugeeprotectionby impeding the entry of asylum seekers and that it establishes a system of negative redistributionfor handling asylumclaimsthat impactsupon Central and EasternEuropean Countries (CEECs).Additionally,the fieldsof asylum and immigration, although not originallypart of the EU's agenda, now play an increasinglyimportantrole in the pre-accessionstrategydeployed vis-a-vis CEECs, and this, the author argues, may place significantobstacles to swift...